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Design-related musings prompted by a hospital stay

A couple of weeks ago I went to hospital in NYC, where I had abdominal surgery to remove apple-sized fibroids from my uterus. A totally innocuous operation, it turns out (so many women I’ve spoken to have either had fibroids themselves, or know someone who has them). But it was my first ever stay in a hospital, and my first ever surgery, and now I’m laid up at home recovering, getting more and more bored by the day. As I regain my strength, I find myself mulling some design-related thoughts–and questions about the healthcare system I haven’t been able to answer. So, purely as personal therapy, here goes nothing.

1. Physical includes mental wellbeing.

When my doctor informed me I’d have to have surgery, she spent about five minutes going through the potential risks, from a perforated bladder to a damaged liver, or was it kidneys? I can’t remember, because at some point during the list I burst into tears and couldn’t take it all in. “There, there,” she said. “I have to tell you these things.” Right before the operation itself, the anesthetist had the same shtick, a focus on describing all the things that might go wrong, the potential pneumonia, etc. I totally understand that they didn’t want me to sue them if anything had gone awry, also that I absolutely need to be an informed patient. But walking into the operating room felt like walking to the gallows. I was petrified. And I can’t help but think that this isn’t exactly the right state of mind in which to go under the knife. After the operation was over I was asked about a heart arrhythmia that had cropped up during the procedure. I wanted to reply, “I’m not SURPRISED my heart was all over the place, goddammit!” though I went with the rather less rude “um, dunno.” What better ways can the system inform patients while allowing them to retain a positive state of mind when they’re going under the knife?

2. The critical importance of floor design.

I confess I hadn’t really paid much mind to floor design before, but now it’s become an obsession. Being wheeled from recovery through the hospital to the ward was an exercise in torture. (Admittedly, this was all playing out at NYU Langone, recently reopened after Sandy shut it down, so I will allow that this means a lot of temporary surfaces as they get back up to full speed.) But even in my morphine-addled state, being bundled into one elevator before being wheeled across the front foyer of the building (itself, frankly, an indignity) in order to access a separate bank of elevators to get to the ward was utter agony. The bumps, jolts, and grates of the journey seared right through the drugs, leading to bursts of expletives from me that freaked out fellow travelers I don’t think were expecting the pale corpse to be interactive. There really isn’t some way to design some kind of ramp from one side of the elevator to the other to guarantee smooth entry and exit? When you’re held together by tape, being bumped about is approximately the worst thing imaginable. And a pox on multi-textured floors that exist for no apparent reason other than aesthetics. Ouch.

2b. How (not) to get from gurney to bed.

“Use your elbows,” I was instructed, as three nurses attempted to get me off the surgical gurney and into my more permanent bed. “Are you fucking kidding me?” I think I replied, before I burst into tears again, stuck half way between the two and feeling like I might literally fall apart at the seams. Isn’t there a better way of transferring people from one to another? The nurses were nice, but I felt them looking at me like I was a crazy person, while I felt like a fish flailing on land. Awful.

3. Interaction design for dummies.

All sorts of amenities are available from a hospital bed. There’s a television that swings around as needed, there’s a call button, there’s a personal light. And I didn’t know how to work any of them. Now admittedly, I was impaired. (Morphine, man. It sure is effective.) But at no point did anyone tell me how to access or operate any of these pieces of equipment. I didn’t even know I had a call button until a nurse pulled the cord off the floor and handed it to me. That went badly later when I promptly dropped it, and had no way to alert anyone that I’d done so (or bend over to pick it up). I also had no idea that when I pressed it, I should be prepared to answer to the disembodied voice of someone answering from who knows where. So for the first day or so I likely pissed off my new protectors something rotten by pressing the button and ignoring the voice that tinned in my ear. Not that I felt like watching it, but I never figured out how to work the television. As for the light system, it was a joke. “Pull the red cord three times,” instructed one doctor who came to visit in the middle of the night. “Three times?” I asked blearily. “Yes, once to activate the thingy, then to, I’m not sure. Then to turn it on,” she replied as she yanked three times on a wire loosely attached to the bed’s headboard. The system was essentially jury-rigged so a patient or doctor can operate the wall switch from the bed. The system was unbelievably badly designed.

4. Acronyms and titles, oh my.

Every person who came into my ward was courteous to a fault, introducing him or herself to me and being sweet, kind, and professional. Nonetheless, I had no idea what 90% of those people were up to. (Except for the guy who came to buff the floor. I knew what he was up to, and I am still incredulous that floor buffing is a practice that happens while immobile patients are lying there.) Each person seemed to have a very official sounding title, and I’m sure that said titles are extremely useful in the internal world of hospital bureaucracy. They are meaningless and confusing to the bleary patient lying in bed. I suppose it doesn’t really matter that I couldn’t distinguish a “registered nurse” from a “patient care technician,” the two who seemed to shoulder the burden of my care, but it’s safe to say that being in a hospital bed is a vulnerable experience. Might have been nice to have some sense of who the hell all these people were. Not least because I’d like to apologize for all my absolute foul-mouthed language as I embarked on my convalescence. What can I say? I blame the morphine.

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2 thoughts on “Design-related musings prompted by a hospital stay”

I saw passing references to a hospital stay on twitter. Very glad you’re on the mend! Having had occasion to shepherd parents through hospital stays, I’ve got to believe that even in the best of circumstances, everybody needs a personal advocate to negotiate logistics. Although a lot of what you talk about involves basic communication (those all-important “soft skills”), there is endless room for improved design. Are you familiar with Michael Graves’ work in this area? http://blog.tedmed.com/?p=579http://www.michaelgraves.com/design/stryker-furnitur.html

Back to communication, one the biggest issues is making sure care-givers (doctors, nurses, companions, family) are all on the same page. There’s a startup in Chicago, Caremerge, that’s been getting a lot of buzz re senior care. I happened to see one of the founders’ presentation at a Technori event a few weeks ago: http://caremerge.com/news/?p=206. The founders actually lived in a senior living facility for six months to better understand the issues. They’re going after an obvious—and growing—market first, but plan to expand. Really impressive group.